Intraoperative neurophysiological monitoring (IONM) is commonly used in various surgical procedures in adults, but with technological and anaesthetic advancements, its use has extended to the paediatric population. The use of IONM in children poses a unique set of challenges considering the anatomical and physiological differences in this group of patients. The use of IONM aids in the localization of neural structures and enables surgeons to preserve the functional neural structures leading to decreased incidence of postoperative neurological deficits and better patient outcomes. In this article, we review the use of IONM in paediatric patients undergoing various spinal and cranial neurosurgical procedures. We discuss the patient characteristics, type of surgeries, and technical and anaesthetic considerations about IONM in this population.